The Critical Shortage of Nursing and Other Direct Care Workers in Long Term Care September 10, 2008

(1)

The Critical Shortage of Nursing

and Other Direct Care Workers in

Long Term Care

September 10, 2008

(2)

Panelists

Robert E. Burke,

The George Washington University

Carolyn Blanks

, Massachusetts

Terry Kuzman

, Connecticut

Cathy Sena

, Florida

Rick Mendlen

, California

(3)

The Views Expressed In this Presentation

Are Based on Past Work Experience.

These Views Are Not to Be Considered as

Representative Any Public, Private,

Federal or State Agency.

(4)

Overview

• The Need for Creative Workforce Options

• National Level Initiatives

(5)

• Key factors that must be addressed to resolve the LTC nursing workforce shortage

– External factors that would increase the number of nurses available and interested in LTC

– Internal factors that would decrease the turnover of nurses by improving the relative attractiveness of the LTC workplace

Long-Term Care

(6)

Recruitment and Retention

Goals

• Improve recruitment by increasing the number of nurses and aides interested in working in LTC

• Improve the retention of nurses by re-engineering the LTC workplace to make it more attractive to

(7)

Nursing Homes are Major Source of

Jobs

2005

2015

Nurse Staff Vacancies

_96,000

_450,000+

(8)

American health care is $ 4.1 billion

dollar industry, 16% of the DNP

• Currently, there are 96,000 full-time vacancies in nursing homes; estimated 434,000 in 2010.

• 216,000 more positions due to retirement and turnover.

• During the period between 2010 and 2025, long-term care jobs will be created at a rate of almost six times the rate of overall labor force growth.

(9)

Commission’s Recommendations

State and Local Initiatives

(10)

State and Local Initiatives

1. Establish broad State level coordinating committees

2. Establish working partnerships at State level 3. Develop financial support for nursing initiatives 4. Promote metro and regional initiatives

5. Improve LTC workplace for nurses and aides by

(11)

Establish State Level

Collaboration

• With health care organizations, educational institutions, nursing education programs, the public workforce,

government, and businesses and foundations

• To understand the factors driving the LTC nursing shortage • To develop a comprehensive set of solutions to the LTC

(12)

Create working partnerships

• With individual nursing education, public workforce, and nursing organizations

• To plan and implement specific programs and projects to improve nursing workforce

(13)

Secure ongoing financial

support

• State Medicaid funds

• State general funds that support nursing education

• DoL Workforce Investment Board funds • Contributions by long-term care providers

(14)

Develop LTC nursing workforce initiatives

in individual metropolitan and regions

• Once State level partnerships and programs are established, a major goal should be to initiate local level activities

• Local activities will be operating programs involving individual ltc facilities and individual nursing colleges, workforce boards and other organizations

(15)

Assist individual facilities to

improve their workplace conditions

• State organizations should actively support facility level initiatives to improve nursing workforce retention

(16)

Work Force Development Efforts

in Massachusetts

Presented by:

Carolyn Blanks

(17)

Why WIBs…?

• LTC can’t solve workforce needs alone

• Expertise to identify and secure funding for LTC

workforce development

• Knowledge and conveners of area workforce

development organizations

• Advocate for LTC in establishing and addressing

regional labor priorities

(18)

History of Collaboration

1999:In partnership with MECF, Boston Private Industry Council secured a U.S. Department of Labor grant to support a CNA career ladder pilot

program-• 90 CNAs in 10 facilities participated in skills training leading to promotions, pay increases and improved retention

• Facilitated relationships with WIBs and other

workforce development agencies who provided TA and resources

• Prototype for statewide Massachusetts Extended Care Career Ladder Initiative (ECCLI)

(19)

ECCLI

• FY2001 state legislative initiative to address CNA shortage(http://www.commcorp.org/eccli/)

• Administered by Commonwealth Corporation

(CommCorp), ECCLI supports career ladders – inc. clinical and soft skills, ABE/ESOL, career coaching, culture change, and supervisory, bridge to nursing and LPN training for LTC workers

• Partners include WIBs, community colleges, One Stop Career Centers, CBOs.

• To date, CommCorp has awarded $15M in grants to 160 LTC employers benefiting 7,500 workers

(20)

ECCLI Outcomes

• Statewide CNA vacancy rates dropped from 15% -8%.

• Increased statewide CNA retention rates by 25%-over 75% of all CNAs employed by facility 25%-over 1 year

• Jumpstarted CNA to LPN programs for over 50

nursing homes and partnering academic institutions • Improved workers’ skills, wages, opportunities for

advancement, self-esteem

• Enhanced workplace relationships, communication, teamwork and morale

(21)

ECCLI Update

• $1.5M in new ECCLI funding in SFY09 state budget • New “employer friendly” program options include

planning, clinical skills, career ladder and innovation grants. WIBs provide outreach and TA.

• Support development of Health Care Learning

Network (HCLN) web-based system that provides contextualized college prep and ESOL to prepare LTC workers for post-secondary nursing or other allied health programs. WIBs, educators and

healthcare providers lead program development.

• Develop/disseminate skills training and ESOL

(22)

Other WIB-LTC Projects

• North Shore LPN Alliance – Kindred Healthcare partnered with other providers, WIB, community

college, career centers to receive 2 rounds of state funding for proprietary CNA to LPN program that graduated 27 new LTC nurses. Additional state grant awarded $500K to develop and pilot HCLN. • Project H.E.A.L.T.H – Berkshire Healthcare

partnered with area WIB, providers and colleges for $500K state grant to recruit/ prepare high/middle

school students to enter healthcare workforce, and provide college prep, tuition, counseling, etc. for those entering LPN program.

(23)

Other WIB-LTC Projects con.

• CAN DO Partnership - Collaboration of academic, healthcare employer, foundation and workforce

development partners that received RWJ/Northwest Health Foundation “Partners Investing in Nursing’s Future” grant to address nursing workforce shortage in Western MA.

Partners include MECF and Genesis HealthCare. LTC specific Nurses Succeed pilot at Genesis’

Heritage Hall campus explored strategies to

increase the enrollment and success of Latino CNAs and nurses pursuing or advancing a nursing

(24)

Building WIB Partnerships

• Establish a relationship: contact your local WIB • Mutual Education Process:

1. Ask about what info, resources, programs, etc., are available to you as a LTC EMPLOYER

2. Educate WIBs on LTC workforce: jobs, skill sets, educational requirements, challenges (Medicaid reimbursement, scheduling)

• Learn how you can connect to existing WIB

(25)

Building WIB Partnerships

• Highlight impact and value of LTC sector to your state and local economies:

– Number of LTC employers/workers

– Current vacancy, retention, turnover rates – include total number of job openings

– Projected growth in LTC demand and employment – see IOM report

– Wages/benefits – career ladders and other opportunities (CNA to LPN wage gain)

(26)

Building Partnerships

• Participate in existing or create new healthcare or LTC-sector specific initiatives to meet your

workforce needs

• Understand YOUR role in the partnership

-commitment of both time and resources. Grants may require employer match, paid leave time while in

training, and/or wage increases

(27)

Workforce Development Efforts

in Connecticut

Presented by:

Terry Kuzman

(28)

Project Co-Ordination – Capital

Workforce Partners

This organization is the workforce investment board for North Central Connecticut.

• 4 North Central Community Colleges • 7 Long-Term Care Facilities

• Connecticut Association of Health Care Facilities, Inc.

• Connecticut Office for Workforce Competitiveness

• Connecticut Association of Non-Profit Providers for the Aging

• Capital Region Education Council • Vernon Adult Education

• 1199 Training and Upgrading Fund

(29)

Department of Labor Grant –

$506,836

Provides on-site incumbent CNA training at no cost to participants. The goal is to build academic, specialty skills and personnel management proficiencies of the CNAs who will earn higher wages and prepare for

advanced skilled health jobs, including the nursing profession.

Robert Wood Johnson Grant - $425,000

Will support work-based learning with 4 of the 7 clinical specialty courses.

(30)

Clinical Specialty Work

• Issues of aging (w/b)

• Dementia and Alzheimer’s (w/b) • Mental Health (w/b)

• Hospice and Palliative Care (w/b) • Medical terminology

• Substance Abuse • Rehabilitation

(31)

Anticipated Outcomes

• 646 incumbent CNAs will receive training at 10 long term care facilities.

• 431 CNAs receive at least one advance credential to qualify for higher wages.

• 72 CNAs will advance to core college work towards nursing or skilled health.

(32)

Current Status

• 114 CNAs currently in program

• 1 Adult Education Completed

• 1 Adult Clinical Education Completed

• 6 of 7 specialty courses have been submitted to community college system for review and

consideration for academic credit

(33)

Workforce Development Efforts

in Florida

Presented By:

Cathy Sena

(34)

(35)

The Florida TRELLIS Concept

Training for Retention & Empowerment through

Ladders & Lattices for Innovative Sustainability

•

• Through Key Partnerships with FHCA, South Florida Through Key Partnerships with FHCA, South Florida

Workforce & Local Education Providers, Our Goal was to

Create a Sustainable Framework for LTC Career Mobility

Opportunities including:

–

– Nursing Career Path including CNA I, CNA II, & LPNNursing Career Path including CNA I, CNA II, & LPN –

– Supervisory and Coaching ClassesSupervisory and Coaching Classes –

– ESOL classes ESOL classes –– vocational language proficiencyvocational language proficiency –

– Classes for Administrators, RNClasses for Administrators, RN’’s and other employees s and other employees within a long term care facility (Customized Training by

within a long term care facility (Customized Training by

MDC)

(36)

Adversity is the Door to

Opportunity

…

TIMTOWTDI

•

• Our Grant Application was Denied! Our Grant Application was Denied! But We Developed

But We Developed Valuable RelationshipsValuable Relationships

•

• Long Term Care Providers/Employers in MiamiLong Term Care Providers/Employers in Miami--DadeDade

continue to access DOL $$$ at local level via

continue to access DOL $$$ at local level via South Florida South Florida Workforce

Workforce Investment Board funding streamsInvestment Board funding streams •

• Florida Health Care AssociationFlorida Health Care Association (Continued to Develop (Continued to Develop CNA II Curriculum)

CNA II Curriculum)

•

• Miami Dade College School of Community EducationMiami Dade College School of Community Education Will Will provide

provide customized coursescustomized courses for employees for employees –– even develop even develop specialized ones that have been identified.

(37)

FHCA Advanced CNA II

Curriculum

…

_…

•

• FHCA has developed a 40 hour CNA II FHCA has developed a 40 hour CNA II

advancement track course beyond the current test

prep course. Ten Modules include:

–

– Aspects of AgingAspects of Aging –

– Managing Pressure UlcersManaging Pressure Ulcers –

– RestraintsRestraints –

– Falls PreventionFalls Prevention –

– Restorative ActivitiesRestorative Activities –

– Compassionate Care at End of LifeCompassionate Care at End of Life –

– Dining Best PracticesDining Best Practices –

– Managing Behavioral ChallengesManaging Behavioral Challenges –

– Improving Incontinence CareImproving Incontinence Care –

(38)

Current Status of Project

…

•

• Transitioning our Transitioning our GOALS to REALITY GOALS to REALITY in Floridain Florida –

– CNA II Curriculum Rolled Out this Past August. $250 for CNA II Curriculum Rolled Out this Past August. $250 for members and $400 for non

members and $400 for non--membersmembers –

– Local WIB Funding Opportunities Readily Available for Local WIB Funding Opportunities Readily Available for Facilities Around Florida Utilizing this Tool

Facilities Around Florida Utilizing this Tool

•

• The The OBJECTIVEOBJECTIVE

–

– Improved Quality & Stability in the LTC Workforce ArenaImproved Quality & Stability in the LTC Workforce Arena –

(39)

Your Local Workforce

Investment Board a Key Partner

•

• CORE MANDATES: CORE MANDATES: Match Employers with Qualified Job Match Employers with Qualified Job Seekers

Seekers and and Train the Workforce to Meet Employer NeedsTrain the Workforce to Meet Employer Needs

•

• EMPLOYER SERVICES:EMPLOYER SERVICES:

–

– SelfSelf--Service HiringService Hiring –

– FullFull--Service HiringService Hiring –

– Tax IncentivesTax Incentives –

– Labor Market InformationLabor Market Information –

(40)

New Workforce Initiatives in FL

•

• RTW (State level funds)

RTW (State level funds)

–

“

Ready to Work

”

Credentialing Program

–

– Reading for InformationReading for Information –

– Applied MathematicsApplied Mathematics –

– Locating Information Locating Information

•

• Temporary Internship Opportunities

Temporary Internship Opportunities

(So. Fla. WF)(So. Fla. WF)

–

– Summer Program for Youth ages 14Summer Program for Youth ages 14--1818 –

– Target High Demand Career FieldsTarget High Demand Career Fields –

(41)

WIBs Also Offer

…

•

• Pre

Pre

-

screening of employee candidates

•

• Career Fairs with Healthcare Employers

Career Fairs with Healthcare Employers

•

• Work Experience & Job Shadowing for Youth

Work Experience & Job Shadowing for Youth

•

• Life Skills & Career Readiness

Life Skills & Career Readiness

-

confidence, skills

enhancement, ESOL, soft skills competency, etc.

•

(42)

Current Trends & Studies

Driving the Opportunities

•

• “Retooling for an Aging America: Building the Health Care “Retooling for an Aging America: Building the Health Care

Workforce

Workforce”” Recent Institute of Medicine report with 13 Recent Institute of Medicine report with 13 recommendations for payers, regulators & educators

recommendations for payers, regulators & educators •

• Proposed Senate Bill: Proposed Senate Bill: ““Improving and Expanding Care for Improving and Expanding Care for

Older Americans Act of 2008

Older Americans Act of 2008” -” - Focus on Focus on CAREGIVER CAREGIVER EDUCATION

EDUCATION

•

• ASSISTIVE TECHNOLOGIESASSISTIVE TECHNOLOGIES in geriatric care will be next big in geriatric care will be next big

trend. Provides practical solution to workforce shortage and

effective retention tool for Gen Y

effective retention tool for Gen Y •

• LONG TERM CARELONG TERM CARE is being recognized as a is being recognized as a separate and separate and

distinct

distinct division within the health care spectrumdivision within the health care spectrum

•

• RESULT: Boost in state and federal funds for LTC training RESULT: Boost in state and federal funds for LTC training

and development programs

(43)

OTHER WORKFORCE

DEVELOPMENT

STRATEGIES

…

_…

•

• Participate in Participate in Career DaysCareer Days at your local elementary, middle & at your local elementary, middle & high schools. Children have an idea as early as 4

high schools. Children have an idea as early as 4thth _grade_grade

what they want to do when they grow up.

•

• Create partnerships with local schools for Create partnerships with local schools for Community Community Service

Service hours hours –– help create opportunities for them to bond help create opportunities for them to bond with the elderly and consider a career in LTC.

with the elderly and consider a career in LTC.

•

• Maximize Maximize IntergenerationalIntergenerational Project Partnership Project Partnership

Opportunities with your WIB and Community (LifeBio.com;

TRECS Project)

•

• Sensible Sensible ImmigrationImmigration Legislation Legislation –– Be a legislative advocate!Be a legislative advocate!

•

• Investing in your WorkforceInvesting in your Workforce is a Proactive Step to Counter is a Proactive Step to Counter the possibility of the

(44)

Resource Links

•

• Department of Labor Website (Newsletter Department of Labor Website (Newsletter –– free free subscription)

subscription) www.workforce3one.govwww.workforce3one.gov

•

• National Association of Workforce Boards (ENational Association of Workforce Boards (E--clips clips Newsletter

Newsletter –– free subscription) www.nawb.orgfree subscription) www.nawb.org

•

• American Health Care Association www.ahca.orgAmerican Health Care Association www.ahca.org

•

• Florida Health Care Association www.fhca.orgFlorida Health Care Association www.fhca.org

•

(45)

Workforce Development Efforts

in California

Presented by:

Rick Mendlen

(46)

CAHF utilizes its educational foundation, Quality Care Health Foundation to evaluate the workforce and develop grant concepts for submission to state agencies

for support. Over the years QCHF has created a number of successful programs and learned a number of hard lessons in the process. To date, our primary partners

have been the California Employment Development Department (EDD), the California Employment Training Panel (ETP), the California Department of Veteran’s

Affairs (DVA) and state and local Workforce Investment Boards with additional assistance from the State Community College Board and the CA Workforce

Association (the advocacy group for the 50+ local WIBs in California)

Relationships Essential to Success!

•Outreach to local manpower sources such as Local WIB “One Stops” make recruitment

smoother.

•Local community colleges assist with screening applicants for programs. While many applicants seem perfectly matched to CNA or LVN training they often have language or other cultural barriers

(47)

Recent California Projects

• CTI (California Caregiver Training Initiative) Grant – 2001 – 2004

– This $10,500,000 grant was intended to train

2000 CNAs, to expand career ladders and recruit “new” caregivers to the industry.

– The grant was developed through the Governor’s Aging with Dignity Initiative and funded via the

Workforce Investment Act

– Administration was a partnership between QCHF & the EDD

– Ultimately, nearly 1,800 new CNAs were added to the CA workforce

(48)

Recent California Projects

Veteran’s Employment Assistance Program - VEAP

• This $480,000 grant was intended to train approximately 100 former medics retiring and/or separating from the armed services. It was hypothesized that these recently separated servicemen and women would have skills

easily translatable to LVN licensure in CA.

• An outside contractor was utilized to assist in recruiting applicants for the program along with assistance from the EDD “One Stops” and their Veteran Placement Counselors

• Nearly 400 veteran’s applied for the program through mail & the Internet

• Utilizing a review process developed by QCHF in

conjunction with a local LVN training entity the applicant list was reduced to 235

(49)

Recent California Projects

• Of the 235 approximately 100 actually entered into the remedial training process to prepare them for the

Licensure Exam

• The list was further reduced by the need for paperwork and delays with the Board of Vocational Nursing and a real disconnect between the LVN requirements and the medics hands-on experience – these disconnects

became real barriers to many of the applicants – they needed employment and were unable or unwilling to deal with the delays imposed by outside agencies.

• Ultimately, even with these barriers we licensed 37 LVNs – most remained in California for employment, but were dispersed throughout long term care, some acute care and agencies such as local fire departments as EMTs

(50)

Recent California Projects

Employment Training Panel (ETP) – CAN to LVN Upgrade Program

• This $180,000 Contract between QCHF and ETP was an effort to identify students in the second half of their LVN

training assuming that those who had completed their first 850 hours successfully were more likely to succeed than a class of new enrollees.

• The initial program recruited 37 LVN students working in long term care and attending accredited training programs – the term of the contract was two-years

• Enrollees were expected to complete the second half of

training, take and pass their NCLEX exam, become licensed and work for a period of 90-days to qualify.

• We received excellent support from two local WIBs as well as a number of training programs

• Of the 37 enrolled, 33 successfully completed all the

requirements and are currently working in long term care in California & 7 have enrolled in RN programs to further their

(51)

Lessons Learned

• The latter two programs were successful, but could have been less labor intensive and better positioned for success if:

– Local WIBs could have been utilized for initial screening of applicants reducing the amount of “hands-on” required by a limited QCHF Staff

– Stronger ties with local WIBs would have assured better communication with applicants through “One Stops” and reduced some of the lag time encountered when dealing with various state and local bureaucracies

• Additionally, closer ties with local WIBs would bring the “long term care” message to the very people in a position to secure funding and set parameters for the programs we need

• CAHF and QCHF continue to encourage our members to participate with their local Boards. We currently have 5 members on local

boards and a member on the State Board. Additionally, we have developed strong ties with a number of state board members to improve communication and to assure that our story is told

(52)

Workforce Development

Efforts

in New York State

Presented By:

Daniel Richardson

(53)

Background

• The Workforce Investment Act was passed by

Congress, signed by President Clinton in 1998

• Governors of each state appoint members of a

State Workforce Investment Board to set policy,

oversee Local Workforce Investment Boards,

which oversee the release of funds

• By statute, both State and Local Boards must be

composed with more than 50% business

members. The Chair must be from the business

sector

(54)

Purpose

• To streamline the myriad of workforce efforts in

existence prior to 1998

• Focus on positive, measurable outcomes for

the end-user, i.e. businesses and workers

• More accountability to the federal government

• There are three basic pools of workers targeted

for assistance-incumbent, emerging and

special populations such as the disabled, youth

and veterans

(55)

Examples of Existing

Opportunities in New York

• Building Skills in New York State (BUSINYS)

provided $66 million to 77,000 workers over the

past several years

• Career Pathways Initiative- $5 million available

to prepare workers for jobs in industries with

advancement opportunity and career ladders

• Utilize the Work Eligible Training Providers in

(56)

Employment Opportunities

Abound within Long Term Care

• Health care and long-term care in particular, are

recognized to be one of three major growth

areas for jobs in New York State

• In the next ten years, New York State health

care providers will add almost 200,000 jobs

• Vacancy rates for professional nurses and

nursing assistants are growing

• The job opportunities within a long-term care

facility are recognized to be excellent entry level

opportunities for new workers

(57)

How to Get Started at Your

Facility

• Visit the Web to find out which Local Workforce

Investment Board(LWIB) operates in your

geographic area. Ask your state association for

assistance

• Pay a visit to the LWIB, meet the director. In

general, they are actively seeking business

partners with job openings, training needs,

career ladders

• Make a list of your vacancies, skills training

needs and compare to already existing

programs in your area. Compare your needs

with other local providers

(58)

How to Get Started at Your

Facility (cont’d)

• Establish a collaborative approach with other

providers. Workforce monies are more easily

located when groups of facilities work together

• Consider engaging the support of a not-for-profit

entity such as a 501 c-3 foundation to the

receive funding. In New York, our sate

association has a separate foundation for this

purpose

• Recognize that you are dealing with a

consortium of government entities. Be patient,

there are usually a variety of methods to obtain

funding

(59)

What You Bring to Your LWIB

as a LTC Provider

• A stable job base

• Opportunity to develop career ladders, allowing

employees to explore new fields of interest,

which enhances their skills and earning power

and improve retention

• Entry level opportunities for new workers,

retraining for existing workers

• Exposure to technology, customer service skills,

which are translational throughout the workforce

(60)

Next Steps

• Initiatives to improve LTC must be based on:

– new partnerships with the LTC community and

– counterparts in the nursing education, workforce, nursing, aging, and health care communities all playing key roles

(61)

Next Steps

• Without dedicated and persistent leadership from LTC

leaders throughout the nation, the other necessary partners will not focus their attention in this area.

• The leadership for LTC nursing workforce efforts must come from the LTC community itself.

(62)

Workforce Challenges

• Increase facility competitiveness and job security through programs that improve incumbent workers’ skills.

– Training that responds to the changing world – Affordable

– Applicable to better paying jobs

• Integrating workers with limited English proficiency

– Coordinated combined approach with skills developments – not an English first approach

(63)

Workforce Challenges

• Respond to small and medium size facilities (less than 500 employees) recruitment and training needs.

– Demand Driven and multi-employer

– Tied to regional economic development

• Meeting employer demand while minimizing effects of layoffs – Effective and fast job matching

(64)

Workforce Challenges

• Assuring a pipeline of skilled workers

– Training for higher paid classifications – Recognized credential

• Continuing a pipeline of young workers – Connected to public schools

– Evidence that the program works to get high school graduates to enter the field.

(65)

For More Information:

Panel Coordinator:

Robert E. Burke, PhD (202)416-0492

Chair, Health Services Management and Leadership GWU

[email protected]

Massachusetts: Carolyn Blanks,

Vice President of Labor and Workforce Development

Mass. Extended Care Federation [email protected] Connecticut: Terry Kuzman [email protected] Florida: Cathy S. Sena, (305) 759-4046 Florida Health Care Association, and Mandarin Health Group

[email protected] California: Rick Mendlen New York: • Daniel E. Richardson (585) 225-0910 X303

Chairman, Workforce Development Committee New York State Health Facilities Association

shortage(http://www.commcorp.org/eccli/

subscription) www.workforce3one.gov

free subscription) www.nawb.org

American Health Care Association www.ahca.org

Florida Health Care Association www.fhca.org

Amazing Stories www.thetrecsinstitute.org